Topic Contents

Covers heartburn and when symptoms may be caused by a more serious problem like gastroesophageal reflux disease (GERD). Offers home treatment and prevention tips. Discusses emergencies. Includes interactive tool to help you decide when to call a doctor.

Heartburn

Topic Overview

Heartburn is a feeling of burning, warmth, heat, or pain that often
starts in the upper abdomen just beneath the lower breastbone (sternum). This
discomfort may spread in waves upward into your throat, and you may have a sour
taste in your mouth. Heartburn is sometimes called indigestion, acid
regurgitation, sour stomach, or pyrosis. It is not caused by problems with your
heart, although sometimes heart problems can feel like heartburn. See a picture
of
heartburn.

Heartburn may cause problems
with swallowing, burping, nausea, or bloating. These symptoms can sometimes
last up to 2 hours or longer. In some people, heartburn symptoms may cause
sleep problems, a chronic cough,
asthma, wheezing, or choking episodes.

Heartburn usually is worse after eating or made worse by lying down or bending
over. It gets better if you sit or stand up.

Almost everyone will
have troubles with heartburn now and then.

Heartburn occurs more
frequently in adults than in children. Many women have heartburn every day when
they are pregnant. This is because the growing uterus puts increasing upward
pressure on the stomach.

Symptoms of heartburn and
symptoms of a heart attack may feel the same.
Sometimes your heartburn symptoms may mean a more
serious problem and need to be checked by your doctor.

Dyspepsia
is a medical term that is used to describe a vague feeling of fullness,
gnawing, or burning in the chest or upper belly, especially after eating. A
person may describe this feeling as "gas." Other symptoms may occur at the same
time, such as belching, rumbling noises in the abdomen, increased flatus, poor
appetite, and a change in bowel habits.
Causes of dyspepsia can vary from minor to
serious.

Causes of heartburn

Heartburn occurs when food and
stomach juices back up (reflux) into the esophagus,
which is the tube that leads from the throat to the stomach. This process is
called
gastroesophageal reflux. Common causes of reflux
include:

Foods and
drinks, such as chocolate, peppermint, fried foods, fatty foods, sugars, coffee, carbonated drinks, and alcohol. After heartburn occurs, the backflow of
stomach juices can cause the esophagus to become sensitive to other foods, such
as citrus fruits, tomatoes, spicy foods, garlic, and onions. Eating these foods
may cause more heartburn.

Pressure on the stomach caused by
obesity, frequent bending over and lifting, tight clothes, straining with bowel
movements, vigorous exercise, and pregnancy.

A
hiatal hernia, which occurs when a small portion of the stomach pushes upward
through the diaphragm, which is the muscle that separates the lungs from the
abdomen.

Stress, which can increase the amount
of acid your stomach makes and cause your stomach to empty more slowly.

Severity of heartburn

Mild heartburn occurs about
once a month. Moderate heartburn occurs about once a week.

Severe
heartburn occurs every day and can cause problems such as trouble swallowing,
bleeding, or weight loss. Heartburn with other symptoms, such as hoarseness, a
feeling that food is stuck in your throat, tightness in your throat, a
hoarse voice, wheezing, asthma, dental problems, or
bad breath, may be caused by a more serious problem, such as
gastroesophageal reflux disease (GERD). A persistent
inflammation of the lining of the esophagus occurs in GERD and can lead to
other health problems. Heartburn may also be related to an infection with
Helicobacter pylori (H. pylori) bacteria.

Persistent heartburn symptoms can be a sign of a more serious medical
condition, such as severe inflammation of the esophagus or cancer of the
stomach or esophagus.

Heartburn is more serious when it occurs
with abdominal pain or bleeding.

Vomiting
of blood may mean bleeding in the digestive tract, often from the esophagus
or stomach. If you have bleeding in the esophagus, stomach, or part of the
small intestine attached to the stomach (duodenum), stools may be dark red or
black and tarry. Large amounts of bleeding can lead to
shock, a life-threatening condition. For more
information, see the topic
Nausea and Vomiting, Age 12 and Older .

Heartburn in children

Almost all babies spit up,
especially newborns.
Spitting up decreases when the muscles of the esophagus,
which is the muscular tube that connects the throat to the stomach, become more
coordinated. This process can take as little as 6 months or as long as 1 year.
Spitting up is not the same thing as vomiting. Vomiting is forceful and
repeated. Spitting up may seem forceful but usually occurs shortly after
feeding, is effortless, and causes no discomfort.

Children who
vomit frequently after eating during the first 2 years of life have increased
chances of having heartburn and reflux problems, such as GERD, later in life.
Children with reflux problems also have increased chances of other problems,
such as
sinusitis, laryngitis, asthma,
pneumonia, and dental problems. For more information,
see the topic
Nausea and Vomiting, Age 11 and Younger .

Treatment

The treatment of heartburn depends on how
severe your heartburn is and what other symptoms you have. Home treatment
measures and medicines that you can buy without a prescription usually will
relieve mild to moderate heartburn. It is important to see your doctor if
heartburn occurs frequently and home treatment does not relieve your
symptoms.

Think about whether the heartburn started after you began taking a new medicine or a higher dose of a medicine.

Yes

Medicine may be causing heartburn

No

Medicine may be causing heartburn

In the past few weeks, have you been losing weight without trying?

Yes

Has been losing weight without trying

No

Has been losing weight without trying

Pain in adults and older children

Severe pain (8 to 10): The pain
is so bad that you can't stand it for more than a few hours, can't sleep, and
can't do anything else except focus on the pain.

Moderate pain (5 to 7): The pain is bad enough to disrupt your
normal activities and your sleep, but you can tolerate it for hours or days.
Moderate can also mean pain that comes and goes even if it's severe when it's
there.

Mild pain (1 to 4): You notice the pain,
but it is not bad enough to disrupt your sleep or activities.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be
able to take care of this problem at home.

Try home treatment to relieve the
symptoms.

Call your doctor if symptoms get worse or you have any
concerns (for example, if symptoms are not getting better as you would expect).
You may need care sooner.

Pain, pressure, or a
strange feeling in the back, neck, jaw, or upper belly, or in one or both
shoulders or arms.

Lightheadedness or sudden
weakness.

A fast or irregular heartbeat.

The more of these symptoms you have, the more likely it is that
you're having a heart attack. Chest pain or pressure is the most common
symptom, but some people, especially women, may not notice it as much as other
symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, numbness,
tingling, or a strange feeling in your chest or other areas.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and
arrange for care.

If you cannot reach your doctor or you don't have
one, seek care in the next hour.

You do not need to call an
ambulance unless:

You cannot travel safely either by driving
yourself or by having someone else drive you.

You are in an area
where heavy traffic or other problems may slow you down.

Many prescription and nonprescription medicines can cause
heartburn. A few examples are:

Aspirin, ibuprofen (such as Advil or Motrin), and
naproxen (such as Aleve).

Antibiotics.

Steroids, such
as prednisone.

Some heart medicines.

Caffeine and alcohol also can cause
heartburn.

Nausea and Vomiting, Age 12 and Older

Seek Care Today

Based on your answers, you may need care soon. The
problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms
and arrange for care.

If you cannot reach your doctor or you don't
have one, seek care today.

Call 911 Now

After you call
911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2
to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Abdominal Pain, Age 12 and Older

Nausea and Vomiting, Age 11 and Younger

Pregnancy-Related Problems

Abdominal Pain, Age 11 and Younger

Home Treatment

Home treatment, such as lifestyle
changes and nonprescription medicines, may be all that is needed to treat mild
to moderate heartburn. But if your symptoms do not get better with home
treatment, or if your symptoms occur frequently,
see your doctor to find out whether other medical conditions may be causing
your symptoms.

Keep a record of your heartburn symptoms before and
after making lifestyle changes or using nonprescription medicines so you can
discuss any improvement with your doctor. See an example of a
heartburn symptom record(What is a
PDF document?).

Medicines to treat heartburn

Note:

If you are pregnant and have heartburn symptoms, be sure to
talk to your doctor before you take any heartburn medicines. Some medicines may
not be safe to take while you are pregnant. For more information, see the topic
Pregnancy-Related Problems .

Antacids

Many people take nonprescription antacids for mild or occasional heartburn. If you use antacids more than just once
in a while, talk with your doctor.

Antacids such as Tums, Mylanta, or Maalox neutralize some of the stomach acid for 30 minutes to 2 hours,
depending on whether the stomach is full or empty. Liquid or dissolving antacids usually work faster than tablet
forms.

Some antacids, such as Gaviscon, have a foaming agent (alginate) that acts as a barrier between stomach
acid and the esophagus.

Antacids such as Pepto-Bismol coat the esophagus and act as a barrier to reflux acid. Pepto-Bismol should
not be used for more than 3 weeks and you should not take it if you can't take aspirin. It may make your tongue
or stools black. The black color is usually not serious. Brushing your teeth and tongue after taking Pepto-Bismol
may keep your tongue from turning black. Ask
your doctor if your child younger than age 12 should take this medicine.

Antacids work faster than acid reducers (H2 blockers), but their effect does not last more than 1 to 2 hours. H2
blockers can provide relief for up to 12 hours.

Antacids do have side effects. They may cause diarrhea or constipation. Also, antacids can interfere with how your
body absorbs other medicines.

If you have any
health risks , talk with your doctor before you start taking an antacid. If you have kidney disease, it
is especially important to discuss antacid use with your doctor. Regular use of antacids that contain magnesium or
aluminum can cause a dangerous buildup of magnesium or aluminum in people who have kidney disease.

Stomach acid reducers

H2 blockers

Acid reducers, also called histamine receptor (or H2) blockers, decrease the amount of acid that the stomach makes,
which may reduce irritation to the stomach lining and decrease heartburn. Some examples of nonprescription acid
reducers are Pepcid AC, Tagamet HB, Zantac 75, and Axid AR. Talk with your doctor if you take an H2 blocker for
more than 2 weeks.

Proton pump inhibitors

Proton pump inhibitors (PPIs), such as omeprazole (for example, Prilosec), reduce stomach acid and effectively
treat severe heartburn symptoms. These acid-reducing medicines are used when your heartburn has not gotten
better with other home treatment measures, antacids, or H2 blockers. You may need to use a PPI for up to 5 days
before you have relief of your heartburn, but they are safe to use for long-term management. They also are safe to
use if you have kidney or liver problems. PPIs are available without a prescription.

Acid reducers can sometimes change the way other medicines work. If you are taking prescription medicines, be
sure to talk with your doctor before you take a nonprescription acid reducer.

Prevention

It's best to eat several small meals instead
of two or three large meals.

After you eat, wait 2 to 3 hours
before you lie down. Late-night snacks aren't a good
idea.

Chocolate, mint, and alcohol can make heartburn worse. They
relax the valve between the esophagus and the stomach.

Spicy foods,
foods that have a lot of acid (like tomatoes and oranges), and coffee can make
heartburn symptoms worse in some people. If your symptoms are worse after you
eat a certain food, you may want to stop eating that food to see if your
symptoms get better.

Do not smoke or chew tobacco.

If you
get heartburn at night, raise the head of your bed
6 in. (15 cm) to
8 in. (20 cm) by putting the
frame on blocks or placing a foam wedge under the head of your mattress.
(Adding extra pillows does not work.)

Do not wear tight clothing
around your middle. Lose weight if you need to. Losing just 5 to 10 pounds can
help. For more information, see the topic
Weight Management .

It will be easier to make lifestyle changes if your family
understands the reasons for the changes. Take a friend or family member to the
appointment with you, and discuss diet and sleeping habits with your
doctor.

Remember to take your
heartburn symptom record(What is a
PDF document?) to your doctor visit. Be sure to note any lifestyle changes
you have made or nonprescription medicines you use.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the
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